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Introduction
The National Center for Complementary and Alternative Medicine (NCCAM)
has developed this fact sheet on the use of St. John's wort for
depression. It is one of a series of fact sheets intended to help
consumers make informed decisions about whether to use complementary and
alternative medical (CAM) therapies for a disease or medical condition.
NCCAM defines CAM practices as those health care and medical practices
that are not currently part of conventional medicine. There are many CAM
practices. A few examples include traditional Chinese medicine,
meditation, chiropractic, therapeutic touch, and herbs.
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Key Facts
St. John's wort is an herb that has been used for centuries for
medicinal purposes, including to treat depression. The composition of
St. John's wort and how it might work are not well understood. There is
some scientific evidence that St. John's wort is useful for treating
mild to moderate depression. However, recent studies suggest that St.
John's wort is of no benefit in treating major depression of moderate
severity. More research is required to help us know whether St. John's
wort has value in treating other forms of depression. St. John's wort
interacts with certain drugs, and these interactions can be dangerous.
Herbal products vary greatly as to their chemical composition and
quality.
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For Your Safety
The information in this fact sheet is not a substitute for
professional medical advice. It is important that you seek the advice of
a health care practitioner about any medical condition or symptom you
are having, or if you are considering taking any herbal preparation. St.
John's wort can interact with prescribed drugs and affect how well they
work.
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Frequently Asked Questions
What is St. John's wort?
St. John's wort (Hypericum perforatum in Latin) is a long-living
plant with yellow flowers. It contains many chemical compounds. Some are
believed to be the active ingredients that produce the herb's effects,
including the compounds hypericin and hyperforin.
How these compounds actually work in the body is not yet known, but
several theories have been suggested. Preliminary studies suggest that
St. John's wort might work by preventing nerve cells in the brain from
reabsorbing the chemical messenger serotonin, or by reducing levels of a
protein involved in the body's immune system functioning.
For what medicinal purposes has St. John's wort been used?
St. John's wort has been used for centuries to treat mental disorders as
well as nerve pain. In ancient times, doctors and herbalists
(specialists in herbs) wrote about its use as a sedative and treatment
for malaria as well as a balm for wounds, burns, and insect bites.
Today, St. John's wort is used by some people to treat mild to moderate
depression, anxiety, or sleep disorders.
What is depression?
Information on depression is available from the National Institute of
Mental Health. Here is a brief overview.
Depression is a medical condition that affects nearly 19 million
Americans each year. A person's mood, thoughts, physical health, and
behavior all may be affected. Symptoms commonly include:
- Ongoing sad mood
- Loss of interest or pleasure in activities that the person once
enjoyed
- Significant change in appetite or weight
- Oversleeping or difficulty sleeping
- Agitation or unusual slowness
- Loss of energy
- Feelings of worthlessness or guilt
- Difficulty "thinking," such as concentrating or making
decisions
- Recurrent thoughts of death or suicide.
Depressive illness comes in different forms. The three major forms are
described below. Each can vary from person to person in terms of
symptoms experienced and the severity of depression.
- In major depression, people experience a sad mood or loss
of interest or pleasure in activities for at least 2 weeks. In
addition, they have at least four other symptoms of depression.
Major depression can be mild, moderate, or severe. If it is not
treated, it can last for 6 months or more.
- In dysthymia, a milder, but more chronic form of
depression, people experience a depressed mood for at least 2 years
(1 year for children) accompanied by at least two other symptoms of
depression.
- In bipolar disorder, also called manic depression, a person
has periods of depressive symptoms that alternate with periods of
mania. Symptoms of mania include an abnormally high level of
excitement and energy, racing thoughts, and behavior that is
impulsive and inappropriate.
Some people still hold outdated beliefs about depression--for example,
that the emotional symptoms caused by depression are "not
real." However, depression is a real medical condition. It can be
treated effectively with conventional medicine, including by
antidepressant drugs and certain types of psychotherapy (talk therapy).
Why is St. John's wort used as an alternative therapy for
depression?
Some patients who take antidepressant drugs do not experience relief
from their depression. Other patients have reported unpleasant side
effects from their prescription medication, such as a dry mouth, nausea,
headache, or effects on sexual function or sleep.
Sometimes people turn to herbal preparations like St. John's wort
because they believe "natural" products are better for them
than prescription medications, or that natural products are always safe.
Neither of these statements is true (this is discussed further below).
Finally, cost can be a reason. St. John's wort costs less than many
antidepressant medications, and it is sold without a prescription (over
the counter).
How widely is St. John's wort used for treating depression?
In Europe, St. John's is widely prescribed for depression. In the United
States, St. John's wort is not a prescription medication, but there is
considerable public interest in it. St. John's wort remains among the
top-selling herbal products in the United States.
How is St. John's wort sold?
St. John's wort products are sold in the following forms:
- Capsules
- Teas--the dried herb is added to boiling water and steeped for a
period of time.
- Extracts--specific types of chemicals are removed from the herb,
leaving the desired chemicals in a concentrated form.
Does St. John's wort work as a treatment for depression?
There has been scientific research to try to answer this question.
In Europe, results from a number of scientific studies have supported
the effectiveness of certain St. John's wort extracts for depression. An
overview of 23 clinical studies, published in the British Medical
Journal in 1996, found that the herb might be useful in cases of
mild to moderate depression. The studies, which included 1,757
outpatients, reported that St. John's wort was more effective than a
placebo (a "dummy" pill designed to have no effect) and
appeared to produce fewer side effects than some standard
antidepressants.
Other studies conducted recently have found no benefit from the use of
St. John's wort for certain types of depression. For example, the
results of a study funded by Pfizer Inc., a pharmaceutical company,
found that St. John's wort, when compared with placebo, was not
effective for treating major depression (Shelton, et al. JAMA,
2001).
In addition, several components of the National Institutes of Health--NCCAM,
the Office of Dietary Supplements, and the National Institute of Mental
Health--funded a large, carefully designed research study to find out
whether St. John's wort extract benefits people with major depression of
moderate severity. This trial found that St. John's wort was no more
effective for treating major depression of moderate severity than
placebo (Hypericum Depression Trial Study Group. JAMA, 2002; for
further information, view
the press release or contact the NCCAM
Clearinghouse).
Are there any risks to taking St. John's wort for depression?
Yes, there are risks in taking St. John's wort for depression.
Many so-called "natural" substances can have harmful
effects--especially if they are taken in too large a quantity or if they
interact with something else the person is taking.
Research from the NIH has shown that St. John's wort interacts with some
drugs--including certain drugs used to control HIV infection (such as
indinavir). It may also interact with drugs that help prevent the body
from rejecting transplanted organs (such as cyclosporine). Using St.
John's wort limits these drugs' effectiveness.
Also, St. John's wort is not a proven therapy for depression. If
depression is not adequately treated, it can become severe and, in some
cases, may be associated with suicide. Consult a health care
practitioner if you or someone you care about may be experiencing
depression.
People can experience side effects from taking St. John's wort. The most
common side effects include dry mouth, dizziness, gastrointestinal
symptoms, increased sensitivity to sunlight, and fatigue.
What are some other possible problems with using St. John's wort?
Herbal products such as St. John's wort are classified as dietary
supplements by the U.S. Food and Drug Administration (FDA), a regulatory
agency of the Federal Government. The FDA's requirements for testing and
obtaining approval to sell dietary supplements are less strict than its
requirements for drugs. Unlike drugs, herbal products can be sold
without requiring studies on dosage, safety, or effectiveness.
The strength and quality of herbal products are often unpredictable.
Products can differ in content not only from brand to brand, but from
batch to batch. Information on labels may be misleading or inaccurate.
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The National Center for Complementary and Alternative Medicine is
dedicated to exploring complementary and alternative healing practices
in the context of rigorous science, training CAM researchers, and
disseminating authoritative information to the public and professionals.
NCCAM Clearinghouse
Toll-free: 1-888-644-6226
International: 301-519-3153
TTY (for deaf and hard-of-hearing callers): 1-866-464-3615
E-mail: info@nccam.nih.gov
NCCAM Web site: nccam.nih.gov
Address: NCCAM Clearinghouse, P.O. Box 7923, Gaithersburg, MD 20898-7923
Fax: 1-866-464-3616
Fax on Demand Service: 1-888-644-6226
The NCCAM Clearinghouse provides information about CAM and about NCCAM.
CAM on PubMed
Web site: www.nlm.nih.gov/nccam/camonpubmed.html
CAM on PubMed, a database accessible via the Internet, was developed
jointly by NCCAM and the National Library of Medicine (NLM). It contains
bibliographic citations (1966 to the present) to articles in
scientifically based, peer-reviewed journals on CAM. These citations are
a subset of the NLM's PubMed system that contains over 11 million
journal citations from the MEDLINE database and additional life science
journals important to health researchers, practitioners, and consumers.
CAM on PubMed also displays links to publisher Web sites, some of which
offer the full text of articles.
National Institutes of Health (NIH)
Building 1
1 Center Drive
Bethesda, MD 20892
Web site: www.nih.gov
NIH's mission is to uncover new knowledge that will lead to better
health for everyone. Made up of 27 separate components, mainly
Institutes and Centers, NIH works toward that mission by conducting and
supporting research, training researchers, and fostering communication
of medical information. Descriptions of each of the Institutes and
Centers, along with their research priorities and links to their Web
sites, can be accessed from the main NIH Web site listed above.
National Institute of Mental Health
6001 Executive Blvd., Rm. 8184, MSC 9663
Bethesda, MD 20892-9663
Web site: www.nimh.nih.gov
Toll-free: 1-800-421-4211
E-mail: nimhinfo@nih.gov
The National Institute of Mental Health is committed to reducing the
burden of mental illness through research on mental disorders and the
underlying basic science of brain and behavior.
NIH Office of Dietary Supplements
Building 31, Room 1B29
31 Center Drive, MSC 2086
Bethesda, MD 20892-2086
Web site: dietary-supplements.info.nih.gov
The Office of Dietary Supplements, whose mission is to explore the
potential role of dietary supplements to improve health care, promotes
the scientific study of dietary supplements through conducting and
coordinating scientific research and compiling and disseminating
research results.
Combined Health Information Database (CHID)
Web site: chid.nih.gov
CHID Online is a searchable and user-friendly database produced by more
than a dozen health-related agencies of the Federal Government,
including NCCAM. This database provides titles, abstracts, and
availability information for health information and health education
resources.
ClinicalTrials.gov
Web site: clinicaltrials.gov
ClinicalTrials.gov provides patients, family members, health care
professionals, and members of the public access to information on
clinical trials for a wide range of diseases and conditions. NIH,
through its National Library of Medicine (NLM), has developed this site
in collaboration with all NIH Institutes and the Food and Drug
Administration (FDA). The site currently contains approximately 5,800
clinical studies sponsored by NIH, other Federal agencies, and the
pharmaceutical industry in over 63,000 locations worldwide.
Computer Retrieval of Information on Scientific Projects (CRISP)
Web site: www-commons.cit.nih.gov/crisp
CRISP is a searchable database of federally funded biomedical research
projects conducted at universities, hospitals, and other research
institutions. The database, maintained by the Office of Extramural
Research at NIH, includes projects funded by NIH and other
health-related Federal agencies.
U.S. National Library of Medicine (NLM)
8600 Rockville Pike
Bethesda, MD 20894
Toll-free: 1-888-346-3656
Fax: 301-402-1384
E-mail: custserv@nlm.nih.gov
Web site: www.nlm.nih.gov
NLM is the world's largest medical library. Services include:
Interlibrary Loan
Most of the general and historical collections of NLM are available
through interlibrary loan to any library. NLM provides copies of
journal articles and lends books, audiovisuals, and microforms.
MEDLINE
MEDLINE, an online consumer health information tool, is NLM's premier
bibliographic database covering the fields of medicine, nursing,
dentistry, veterinary medicine, the health care system, and
preclinical science. MEDLINE contains indexed journal citations and
abstracts now covering nearly 4,500 journals published in the United
States and more than 70 other countries.
Web site: medlineplus.nlm.nih.gov/medlineplus
National Network of Libraries of Medicine (NN/LMŪ)
NLM is a national resource for all U.S. health science libraries
through NN/LMŪ. The service will refer inquirers to their nearest NN/LM-affiliated
medical library.
Toll-free: 1-800-338-7657
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American Herbal Pharmacopoeia and Therapeutic Compendium. St. John's
wort (Hypericum perforatum) Monograph. Herbalgram: The Journal
of the American Botanical Council and the Herb Research Foundation.
1997; (40):1-16.
American Psychiatric Association. Diagnostic and Statistical
Manual of Mental Disorders, Fourth Edition (DSM-IV). Washington, DC:
American Psychiatric Association, 1994.
National Institute of Mental Health. Fact Sheets on
Depression--"The Invisible Disease: Depression,"
"Depression Research at the National Institute of Mental
Health," and "The Numbers Count: Mental Disorders in
America," available online at www.nimh.gov
or see "For More Information" above.
Hypericum Depression Trial Study Group. Effect of Hypericum
perforatum (St. John's wort) in major depressive disorder: a
randomized, controlled trial. JAMA, 2002; 287:1807-14.
Shelton RC, Keller MB, Gelenberg AJ, et al. Effectiveness of St.
John's wort in major depression. JAMA, 2001; 285:1978-86.
Linde K, et al. St. John's wort for depression--an overview and
meta-analysis of randomized clinical trials. Br Med J, 1996;
313:253-8.
Piscitelli SC, et al. Indinavir concentrations and St. John's wort. The
Lancet, 2000; 355:547-8.
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This document is not copyrighted and is in the public domain.
Duplication is encouraged. Please give source credit to the National
Center for Complementary and Alternative Medicine.
Office of Communications and Public Liaison
National Center for Complementary and Alternative Medicine
NCCAM Publication #D005
Revised April 9, 2002
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| Inclusion of a treatment or resource in this
fact sheet does not imply endorsement by the National Center for
Complementary and Alternative Medicine, National Institutes of
Health, or U.S. Public Health Service. |
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